Provider Demographics
NPI:1528040821
Name:KAZA, SOMASEKHARAM (MD)
Entity Type:Individual
Prefix:
First Name:SOMASEKHARAM
Middle Name:
Last Name:KAZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SOMA
Other - Middle Name:SEKHARAM
Other - Last Name:KAZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:1200 E BRIN STREET
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160
Mailing Address - Country:US
Mailing Address - Phone:972-551-8217
Mailing Address - Fax:972-551-8053
Practice Address - Street 1:2435 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-6712
Practice Address - Country:US
Practice Address - Phone:972-291-6808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK190402084P0805X
TXJ48752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100219600BMedicaid
OK100219600BMedicaid
F88970Medicare UPIN